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Flashcards in Medical Emergencies Deck (51)
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1

Allergic Reaction
Information:

S/S: Allergic reactions are characterized by any of the following: urticaria, mild respiratory distress, difficulty swallowing, or swelling of the tongue and/or face.

2

Allergic Reaction
Adult: BLS Standard Requirements

• Determine the source of the allergic reaction (insect, food, medications, etc.).
• Assist patient with Epi Pen administration under the following circumstances:
• Patient is prescribed the Epi Pen
• Patient presents with respiratory distress and/or hypotension (shock)

3

Allergic Reaction
Adult: Mild

BENADRYL: 50mg IV/IO/IM. Administer over 2 minutes for IV/IO usage.

4

Allergic Reaction
Adult: Moderate

FOR MILD AIRWAY SWELLING/ MILD RESPIRATORY DISTRESS/ BRONCHOSPASM/ TONGUE AND/OR FACIAL SWELLING
• EPINEPHRINE: (1:1,000) 0.3mg (0.3mL) IM. May repeat 2x prn in five minute intervals. • Do not administer within 5 minutes of Epi-Pen administration
• BENADRYL: 50mg IV/IO/IM. Administer over 2 minutes for IV/IO usage.
• ALBUTEROL: For bronchospasm, 2.5mg via nebulizer, repeat prn.
• Solumedrol 125mg IV/IO/IM one dose

5

Allergic Reaction
Adult: Severe- Anaphylactic Shock

CHARACTERIZED BY THE SIGNS AND SYMPTOMS OF AN ALLERGIC REACTION, IN ADDITION TO THE LOSS OF A RADIAL PULSE AND/OR SBP OF LESS THAN 100mmHg
• Establish a second IV/IO.
• Push Dose EPINEPHRINE:
• NORMAL SALINE: 1L. Assess lung sounds and BP every 500 mL.
• Administer BENADRYL, SOLUMEDROL, and ALBUTEROL as noted above.

6

Allergic Reaction
Pediatric: Mild

BENADRYL: 1mg/kg IV/IO or IM SEE PEDIATRIC MEDICATION if unable to obtain IV access. Max total dose 50mg. Administer over 2 minutes for IV/IO usage.

7

Allergic Reaction
Pediatric: Moderate

FOR MILD AIRWAY SWELLING/ MILD RESPIRATORY DISTRESS/ BRONCHOSPASM/ TONGUE AND/OR FACIAL SWELLING
• EPINEPHRINE IM: (1:1,000) 0.01mg/kg (0.01mL/kg). Max single dose 0.3mg. May repeat 2x prn, in 5 minute intervals. (SEE PEDIATRIC MEDICATION TOOL)
• BENADRYL: 1mg/kg IV/IO (diluted) SEE PEDIATRIC MEDICATION . Max total dose 50mg. Administer over 2 minutes for IV/IO usage. OR give IM
• Benadryl IM: Do not dilute -SEE PEDIATRIC MEDICATION
• ALBUTEROL: For bronchospasm, 2.5mg via nebulizer, repeat prn.
• SOLUMEDROL: 2 mg/kg AS PER PEDIATRIC MEDICATION TOOL

8

Allergic Reaction
Pediatric: Severe- Anaphylactic Shock

CHARACTERIZED BY THE SIGNS AND SYMPTOMS OF AN ALLERGIC REACTION, IN ADDITION TO THE LOSS OF DISTAL PULSES
• Establish a second IV/IO but do not delay treatment
• Push Dose EPINEPHRINE
• NORMAL SALINE: 20mL/kg bolus IV/IO, may repeat 2x prn for hypotension. Check lung sounds often.
• Administer BENADRYL, SOLUMEDROL, and ALBUTEROL as noted above.

9

Altered Mental Status
Information

Consider the possible causes: AEIOU-TIPS, meningitis, and/or dehydration.

10

Altered Mental Status
Adult and Pediatric
Mental Status (AVPU)

• Alert: to person, place, time, and event (AAOX4)
• Verbal: responds only to verbal stimuli
• Pain: responds only to painful stimuli
• Unresponsive

11

Altered Mental Status
Adult and Pediatric
BLS Standard Requirements

• Check and record BGL, if less than 60 mg/dL, follow the hypoglycemia protocol.
• Identify possible causes: stroke, seizures, diabetic problem, drugs, EtOH, CO poisoning.
• Place unresponsive patients in the recovery position (if no suspected spinal cord injury), and suction as needed.
• Paramedic assist: Vitals, glucose, IV, ECG.

12

Altered Mental Status
AEIOU-TIPS

A- Alcohol
E- Epilepsy
I- Insulin
O- Overdose
U- Uremia (Kidney Failure)

T- Trauma
I- Infection
P- Psychiatric
S- Stroke

13

Diabetic Emergencies
Information

Symptoms of DKA include: nausea/vomiting, abdominal pain, general weakness, Kussmaul Respirations, AMS, hypotension, or tachycardia with an acetone smell on the patient’s breath.
• Florida Incapacitated Persons Act
• Criteria for Hypoglycemia resolution and refusal: Insulin only and no pills, total return to baseline mental status, direct access to food, family member to monitor.
• Consider: Hypoglycemia in many cases is a result of severe systemic illness

14

Diabetic Emergencies
Adult- If Blood Glucose is Less Than 60 mg/dl

• Check and record BGL, if less than 60 mg/dL, and patient is able to protect their airway/swallow, give oral glucose. Place unresponsive patients in the recovery position (if no suspected spinal injury), and suction as needed.
• ORAL GLUCOSE: (15g) May be given if patient is able to swallow and follow commands. Repeat as needed for blood glucose less than 60mg/dL.
• D10: 100 mL IV, retest glucose. If patient remains less than 60 mg/dL, administer another 100 mL of D10. Repeat as needed for blood glucose less than 60.

15

Diabetic Emergencies
Adult- If unable to Obtain IV Acciss

Perform Proximal Humerus IO and administer D10: 100mL, retest glucose. If patient remains less than 60 mg/dL administer another 100 mL of D10. Repeat as needed for blood glucose less than 60.

16

Diabetic Emergencies
Adult- IF BLOOD GLUCOSE LEVEL IS GREATER THAN 300 mg/dL WITH S/S OF DKA

• NORMAL SALINE: 1L. Assess lung sounds and blood pressure every 500mL.
• ZOFRAN: 4mg IM or slow IV/IO/PO over 2 minutes for nausea/vomiting.

17

Diabetic Emergencies
Patients Taking Oral Hypoglycemic medications.

Patients taking oral hypoglycemic mediations should be transported to the ED regardless of post treatment glucose levels. (i.e. Glyburide, Glimepiride, and Glipizide)

18

Diabetic Emergencies
If Unable to Provide Standard Hypoglycemia Treatment.

• GLUCAGON: 1mg IM if available.
• Glucagon may cause nausea/vomiting.
• ZOFRAN: 4mg IV/IM/PO for nausea/vomiting.

19

Diabetic Emergencies
Pediatric- If Blood Glucose Levels are Less Than 60 mg/dl

• ORAL GLUCOSE: (15g) may be given to conscious patients with an intact gag reflex. Not recommended for patients less than 2 years old.
• D10: 5ml/kg IV/IO (max of 100 mL), retest glucose. May repeat 1x prn. SEE PEDIATRIC MEDICATION TOOL

20

Diabetic Emergencies
Pediatric- If Blood Glucose Levels are Greater Than 300 mg/dl with S/S of DKA

• NORMAL SALINE: 20mL/kg IV/IO. Assess lung sounds and blood pressure often.
• ZOFRAN: 0.1mg/kg IM or slow IV/IO/PO for nausea/vomiting per the PEDIATRIC MEDICATION TOOL.

21

Diabetic Emergencies
Pediatric- If Unable to Provide the Standard Hypoglycemia Treatment

• GLUCAGON: Less than 20kg (0.5mg IM ), greater than 20kg (1mg IM ) if available.
• Glucagon may cause nausea/vomiting.
• ZOFRAN: 0.1mg/kg IM or slow IV/IO/PO for nausea/vomiting per the pediatric medication tool.

22

Dystonic Reaction
Information

Dystonic reactions are characterized by intermittent spasmodic or sustained involuntary contractions of muscles in the face, neck, trunk, pelvis, extremities, and even the larynx. Typically, antipsychotic (Haldol, Lithium, etc.), antiemetic (Compazine, Reglan, etc.) or antidepressant (Prozac, Paxil etc.) medications are responsible. A dystonic reaction can occur immediately or be delayed for hours to days.

23

Dystonic Reaction
Adult

BENADRYL : 50mg IV/IO/IM. Administer over 2 minutes for IV/IO usage.

24

Dystonic Reaction
Pediatric

BENADRYL: 1mg/kg IV/IO/IM SEE PEDIATRIC MEDICATION
Max total dose 50mg. Administer over 2 minutes for IV/IO usage. BENADRYL IM: SEE PEDIATRIC MEDICATION

25

Fluid Resuscitation/ Dehydration
Information

For dehydration secondary to: prolonged vomiting and/or diarrhea, DKA, heat illness, pneumonia, non- traumatic bleeding (vaginal or GI), suspected Rhabdomyolysis, Paramedic discretion, or hypotension secondary to overdose/poisoning.

26

Fluid Resuscitation/ Dehydration
Adult

NORMAL SALINE: 1L. Assess lung sounds and blood pressure every 500mL.
* Precaution for patients with history of CHF and /or Renal Failure
• Consider sepsis for all dehydrated patients.
• Patients with a history of renal failure/dialysis or CHF are at increased risk for fluid overload. Monitor these patients carefully.

27

Fluid Resuscitation/ Dehydration
Pediatric

NORMAL SALINE: 20mL/kg bolus IV/IO, may repeat 2x prn for continued hypotension. Assess lung sounds and blood pressure often.

28

Hyperkalemia
Information

Consider hyperkalemia in patients with a history of renal failure/dialysis who are pre- dialysis and present with: general weakness, hypotension, paresthesia, tall peaked T-waves (most prominent early sign), or arrhythmias (sine wave, wide complex QRS, V-Tach (with rate lower than 120 bpm), severe bradycardia, or high degree AV blocks)

29

Hyperkalemia
Adult (for patients presenting with arrhythmias indicative of hyperkalemia)

• CALCIUM CHLORIDE: 1 gram, slow IV/IO over 2 minutes.
• ALBUTEROL: 10 mg via nebulizer, (4 * 2.5mg) continuous treatments.
* If patient is intubated, administer Albuterol via in line nebulization.
• SODIUM BICARBONATE: 50 mEq, slow IV/IO over 2 minutes.

IF PATIENT IS HYPOTENSIVE
Administer NORMAL SALINE: 500mL, may repeat 1x prn. Check lung sounds after each fluid bolus.

30

Hyperkalemia
Pediatric ( for patients presenting with arrhythmias indicative of hyperkalemia)

• CALCIUM CHLORIDE: 20 mg/kg, slow IV/IO over 2minutes. (AS PER PEDS MED TOOL)
• ALBUTEROL:10mgvia nebulizer, (4 * 2.5mg) continuous treatments.
• Sodium Bicarbonate: SEE PEDIATRIC MEDICATION TOOL